Evolving Organizations and Responsibilities

Welcome to the second decade of the twenty-first century, which promises to be even more dramatic for health policy than was the first. Although the Patient Protection and Affordable Care Act was enacted into law last year, we do not yet know more than the outlines of the changes it may bring about. The Administration has only just begun work on the multitude of regulations necessary to implement the legislation. Equally important, and uncertain, will be the reactions of the private healthcare sector.

What we do know is that the individuals and organizations that examine the new landscape and seek out the opportunities created by the Affordable Care Act will have the best shot at determining their own future. In this issue of the Communique?, we explore some of the ramifications of the Act’s emphasis on integrated health care systems (IDSs). Kathryn Cruz- Hicks, Esq. and Adrienne Dresevic, Esq. provide an overview in their article Federal Healthcare Reform: The Push for Quality, Efficiency and Integration. Various types of IDSs are identified in Moe Madore’s article Where Do We Fit in the Alphabet Soup? Karin Bierstein, JD, MPH discusses one important method of allocating revenues between physician and institutional providers in a way that also rewards measurable “quality,” in her review The PROMETHEUS Payment® Model: Dividing the Pie for an Episode of Care.

Anesthesiologists already practice in large groups to a much greater extent than office-based specialties and are aware that growth may create antitrust exposure. Daniel Brown, Esq. and Neda Mirafzali, Esq. explain the basic principles of applicable antitrust law in Size Matters: Antitrust Warning Signs in Anesthesia Group and Pain Group Mergers. Part of the challenge of keeping up with healthcare reform is realizing that the Justice Department and the FTC have been looking at ways to reconcile the needs of new healthcare delivery vehicles with traditional approaches to promoting market competition.

Corporate consolidation is not the only path toward success in the new environment. The article that begins on the first page, How to Increase Practice Revenue by Improving OR Efficiency by Jeffry Peters, MBA, President of Surgical Directions, LLC, is a thoughtful as well as highly practical roadmap for anesthesia groups to add value to their facilities in the form of better OR utilization. I draw your attention in particular to the OR performance benchmarks appearing in the table on page 5. A wealth of experience lies behind Mr. Peters’s information that a goal of at least 90 percent on-time starts (within five to seven minutes of scheduled start time) is achievable.

Not just OR, but also nurse anesthetist and anesthesiologist assistant scheduling have a major impact on groups’ profitability. Stephanie Zvolenski, MBA offers an analysis of the challenges of satisfying the increased demand for services through more efficient scheduling of anesthetists.

For some anesthesiologists, success—or at least survival—has appeared to require non-equity arrangements, notably employment by the hospital. Jody Locke, CPC, Vice President of Pain and Anesthesia Management for ABC, reviews the paradoxes of employment in his article Are Anesthesia Providers Destined to Become Hospital Employees?

Mark Weiss, Esq. reminds us in Group to Group: The Impact of Organization Culture that there is more to a successful acquisition or merger than a great match between the resources and assets of anesthesia groups. There must be a balanced integration of the formerly separate organizations’ respective cultures as well. K.D. Lowe, Senior Vice President for ABC-Western Region and his team share some of the lessons learned during a corporate acquisition of our own in Business Consolidations: Lessons Learned During The Acquisition of Associated Anesthesiologists, Inc. By Anesthesia Business Consultants.

All of this is not to say that every anesthesia practice will be better off if it integrates with other corporate entities. There are many practices, including clients of our own, that are going to thrive during the coming decade as they have in past years. It is likely, however, that they will demonstrate some of the quality and value enhancements that larger groups and one-stop shopping healthcare organizations can offer. For the benefit of every evolving anesthesia practice, we will continue to study and provide information on the many types of value enhancements that anesthesiologists can offer.

With best wishes,

Tony Mira
President and CEO